Most adults in England with high blood pressure had no diagnosis and no treatment

Wenyu Liu, a medical statistician at Oxford Population Health, analysed clinic blood pressure readings from 1.4 million adults in England and found that 37% met the criteria for hypertension. Of those, 59% had never been diagnosed and were not taking any blood-pressure-lowering medication. Oxford announced the work on September 23, 2026, and it appears in BMJ Public Health.

Liu put the verdict bluntly: “the current approach to detecting and treating high blood pressure is not fit for purpose.” Iain Turnbull, Deputy Chief Medical Officer at the Future Health research programme whose data the analysis used, said that many patients with high blood pressure are undetected or are sub-optimally treated. Professor Bryan Williams of the British Heart Foundation added that millions of people are still living with the condition without knowing it.

Defining the undetected 59 percent

The University of Oxford’s release on the analysis defines hypertension by the World Health Organization criteria: a systolic reading of at least 140 mmHg, a diastolic reading of at least 90 mmHg, or current use of blood pressure medication. Participants were counted as undetected when they had never received a diagnosis and were not on treatment. The 59% is therefore a share of people who have hypertension, not a share of all adults, and the 37% prevalence sets the larger denominator.

One discrepancy sits in the release itself. Its title says two-thirds of adults with high blood pressure do not know they have it, while the sentence in its text says “almost two-thirds (59%).” The EMJ review of the study noted the gap, pointing out that two-thirds would be about 67%. The figure that matches the data is 59%, a clear majority and not quite three in five.

Prevalence climbed steeply with age. It was 15% among adults aged 18 to 39 and 71% among those aged 80 and over. Age-standardised, 42% of men met the criteria against 29% of women, according to the News-Medical account of the paper. Put another way, roughly one adult in seven in the youngest band met the criteria, against more than two in three in the oldest.

Treated patients still above 140/90

Detection was only part of the gap, and the second half of the finding concerns people who had already been given a prescription. Among participants who were already taking blood pressure medication, 50% still had readings at or above 140/90 mmHg when measured. The shortfall therefore runs in two directions: a majority of people with hypertension in the cohort were never picked up, and half of those who were picked up and medicated were not controlled.

Treatment control is measured against the same thresholds used to define the condition, so a participant could be on medication, counted as having hypertension, and still be above 140/90 on the day of the clinic reading. Liu’s “not fit for purpose” remark was aimed at the detection-and-treatment pathway as a whole, and the authors called for population-wide prevention strategies alongside better case-finding. News-Medical’s summary of the BMJ Public Health paper adds that current NICE guidance, which requires multiple confirmatory readings and lifestyle advice before medication, is cited as one contributor to underdiagnosis and inadequate control across England.

Volunteer cohort and national reach

The readings came from the UK programme called Future Health, a charity-run programme that aims to bring together up to five million volunteers across the United Kingdom. Participants in this analysis enrolled between 2022 and 2025, and their blood pressure was measured at clinic appointments run by the programme.

Two scope points matter for how far the 59% figure stretches. The programme recruits volunteers rather than drawing a random sample, and its NIHR BioResource entry describes UK-wide recruitment with 28 centres across England supporting participation. Oxford frames the result as a picture of hypertension in England, which is the population the 1.4 million figure is attached to in its release. The sources read for this article do not describe any weighting to the national population, so the 59% is best read as the finding in this very large cohort of adults who took part, with England as the setting Oxford names.

Within that cohort the arithmetic is plain: 37% with hypertension, 59% of them undetected, and half of the treated group above target. The British Heart Foundation’s Williams, who holds the post of Chief Scientific and Medical Officer, made the point that millions of people are living with the condition unaware, and that claim rests on extending those proportions to the wider adult population of England, an extension the Oxford release makes and the cohort design does not by itself guarantee. Whether the proportions hold in the wider population is a question only a nationally representative survey of measured blood pressure could settle.

This article was produced with the assistance of AI and reviewed by Morning Overview editors prior to publication.

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